Things that leave you stunned.

*ChristineN* · Jul 04, 2009, 11:19 AM

Re: Things that leave you stunned.

Originally Posted by Oz2

Can I ask a question (I'm not a nurse yet)? What would happen if you let it all drain out? I would feel nervous about clamping it off....like maybe it would burst her bladder!

Losing a large amount of fluid in a very short period of time can be bad for a pt. The pt might become hypotensive. As a result, you need to try to remove it gradually. Since the pt had already voided 2200cc, it's highly doubtful she's going to burst her bladder. Plus, I'm guessing the OP didn't leave it clamped for very long, maybe an hour or two.

NurseKitten · Jul 04, 2009, 11:24 AM

Re: Things that leave you stunned.

Originally Posted by Oz2

Can I ask a question (I'm not a nurse yet)? What would happen if you let it all drain out? I would feel nervous about clamping it off....like maybe it would burst her bladder!

Bladder is innervated by the parasympathetic nervous system, primarily. The "rest and digest", "feed and breed" system.

If you allow it to drain so rapidly, you provide a HUGE stimulus to the PSNS, and could precipitate a drop in heart rate, cardiac output, blood pressure, etc etc etc.

Of course, depending on who you talk to, some don't clamp at all and just let it drain.

But if someone's putting out that much urine, that quickly, and the IV fluids AREN'T running wide open, something else is seriously going on.

E.R. Rookie · Jul 04, 2009, 11:46 AM

Re: Things that leave you stunned.

WOW! Thank you for sharing, interesting stuff!

*Oz2* · Jul 04, 2009, 11:53 AM

Re: Things that leave you stunned.

Thank you ChristineN and NurseKitten!

cherrybreeze · Jul 04, 2009, 12:04 PM

Re: Things that leave you stunned.

This is on a little different vein. Stunned me none the less, only because in over 13 years in healthcare, I've never seen it before.
Patient I had the last two days, had her nose removed due to cancer. Her entire nose. She was left with a hole in the middle of her face (it was hard to tell where the feeding tube was going). The removal was done about 10 years ago. That wasn't the part that shocked me the most, though....that was when the pt's daughter told me it had been removed in the office under LOCAL ANESTHETIC.

That woman is braver than I ever will be. Ever.

Bumashes · Jul 04, 2009, 12:21 PM

Re: Things that leave you stunned.

Originally Posted by Oz2

Can I ask a question (I'm not a nurse yet)? What would happen if you let it all drain out? I would feel nervous about clamping it off....like maybe it would burst her bladder!

In addition to the other's responses, I just did a CEU about bladder management and read something interesting. They instructed to only let out between 750-1000cc at a time because of the pressure that the full bladder may be putting on the pt's pelvic blood vessels. If the pressure is suddenly gone from these vessels, then it can send the pt into hypotension very quickly.

NewTXnurse · Jul 04, 2009, 12:56 PM

Re: Things that leave you stunned.

This happened while I was a student working with a school nurse, a 5th grader came to the nurse complaining that her eyes were bothering her. The student asked if we had any fluid she could place her contacts in. We were freaking out - a 5th grader with contacts??? Oh it gets worse....... Since we were in the windy season we explained that during this time of year it was best for her to wear her glasses instead of contacts. The student replied that she doesnt have glasses and that she doesn't need contacts to see, instead her mom had bought the contacts for her over the weekend at the swap meet to change her eye color!!!!

*Ruby Vee* · Jul 04, 2009, 01:23 PM

Re: Things that leave you stunned.

Originally Posted by shugrr22107NA

aside from amazement my first thought was, that lady would make a GREAT Nurse....she could go a whole shift before a break!

We recently had a PT with a huge bladder also, his skin was suffering and has improved greatly since the cath...now if we can just keep him from messing around with it until his treatment!

Looking forward to hearing more on this thread, the human body is amazing!!

I'm pitying the poor Physical Therapist -- not only does everyone know the size of his bladder, but about his skin problems and cath, too.

*Ruby Vee* · Jul 04, 2009, 01:30 PM

Re: Things that leave you stunned.

Had a patient come in with necrotizing fasciaitis. (I can't SPELL that worth a darn -- I hope everyone knows what I mean!) He walked in off the golf course because "my leg hurts a bit." By the time he got up to our ICU, most of the meat had sloughed off the front of his legs. Went to OR for debridement, and when he came back from OR, they turned him over and the backs of his legs had liquified. He died within hours.

Another patient went to OR for an exploratory laporotomy. They just opened and closed because he had dead bowel, and brought him to the ICU to die. He pooped out his entire pinkish-grey bowel! It was the nastiest looking (and smelling) thing I have EVER seen. It was a good thing he wasn't conscious because I was puking in the corner of the room while my manager, the resident and the RT cleaned him up. And no one said a thing to me, either . . . although I was so ashamed of myself!

Kimbalou · Jul 04, 2009, 01:43 PM

Re: Things that leave you stunned.

Originally Posted by Pepper The Cat

I thought it would be interesting to share stories about things we've seen that just totally amaze us.
Here is my story.

I was helping a collegue cath a pt yesterday. This pt was incontinent of urine - large amts (this is important) and her bottom was so excoriated it was bleeding. So we decidied a cath would help this heal.
She voided a large amt (important) while we were positioning her, but we went ahead anyway.
Got the cath in - it drained 2200 cc (not a typo) in less than half an hour! We were stunned. We clamped the cath because we were worried about side effects from draining so much so quickly. Unclamped an hour later and got another 1000cc! We are still in shock. Plus, the urine was very clear - not the concentrated gunk that you usually get when someone is in retention. This ladie's bladder must have been the size of a basketball!
Her abd certainly was softer after all of this!

ugh, another reason I prefer babies.

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Things that leave you stunned.

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